Drug Therapy Problems

What is a drug therapy problem?

Any undesirable event experienced by a patient that involves, or is suspected to involve, drug therapy, and that interferes with achieving the desired goals of therapy and requires professional judgement to resolve

What is the purpose of resolving a drug therapy problem?

• Help patients achieve their goals of therapy

• Achieve the best possible outcomes

3 factors of a drug therapy problem

1. An undesirable event or risk of an event experienced by the patient

2. The drug therapy associated with the problem

3. The relationship that exists between the undesirable patient event and drug therapy

   1. Consequence of drug therapy

   2. Need to add or modify drug therapy

What are the 7 common causes of drug therapy problems?

1. The drug therapy is unnecessary because the patient does not have clinical indication at this time.

2. Additional drug therapy is required to treat or prevent a medical condition in the patient.

3. The drug product is not being effective at producing the desired response in the patient.

4. The dosage is too low to produce the desired response in the patient.

5. The drug is causing an adverse reaction in the patient.

6. The dosage is too high, resulting in undesirable effects experienced by the patient.

7. The patient is not able or willing to take the drug therapy as intended.

What are the 4 categories of drug-related needs?

1. Indication

2. Effectiveness

3. Safety

4. Adherence

What categories of drug therapy problems is related to “Indication”?

• Unnecessary drug therapy

• Needs additional drug therapy

What categories of drug therapy problems is related to “Effectivness”?

• Ineffective drug

• Dosage too low

What categories of drug therapy problems is related to “Safety”?

• Adverse drug reaction

• Dosage too high

What category of drug therapy problems is related to “Adherence”?

• Nonadherence or noncompliance

What is the difference between the first 6 categories of drug therapy problems and the 7th?

Categories 1-6 are related to experiences resulting from the actions of a drug, while category 7 is based on the results of patient actions

“Unnecessary Drug Therapy”

• Multiple drug products being used for a condition that requires single-drug therapy

• There is no valid medical indication for the drug therapy at this time

• The medical condition is more appropriately treated with non-drug therapy

• Drug abuse, alcohol use, or smoking are causing the problem

• Drug therapy is being taken to treat an adverse reaction associated with another medication

“Needs Additional Drug Therapy”

• Preventative drug therapy to reduce the risk of developing a new condition (e.g., immunizations)

• A medical condition requires the initiation of drug therapy (e.g., statin therapy for high cholesterol)

• A medical condition requires additional pharmacotherapy to attain synergistic or additive effects (e.g., insulin)

“Ineffective Drug”

• The drug product is not the most effective for the indication being treated

• The medical condition is refractory to the drug product

• The dosage form of the drug product is inappropriate

• Contraindication is present

• The drug is not effective for the medical problem

“Dosage Too Low”

• Dose is too low to produce the desired response

• Needs additional monitoring to determine that the dosage is too low

• The dosage interval is too infrequent to produce the desired response

• Incorrect administration of the drug

• A drug interaction reduces the amount of active drug available

• Incorrect storage of the drug

• The duration of drug therapy is too short to produce the desired response

“Adverse Drug Reaction”

• The drug product causes an undesirable reaction that is not dose-related

• A safer drug product is required due to risk factors

• A drug interaction causes an undesirable reaction that is not dose-related

• Incorrect administration of the drug product

• The drug product causes an allergic reaction

• The dosage regimen was administered or changed too rapidly

• The drug product is contraindicated due to risk factors

“Dosage Too High”

• Dose is too high

• Needs additional monitoring to determine if dosage is too high

• The dosing frequency is too short

• The duration of drug therapy is too long

• A drug interaction occurs resulting in a toxic reaction to the drug product

“Adherence”

• Patient does not understand the instructions

• Patient cannot afford the drug product

• Patient prefers not to take the medication

• Patient forgets to take the medication

• The drug product is not available for the patient

• Patient cannot swallow or self-administer the drug product appropriately

How to properly describe a drug therapy problem

• A description of the patient’s medical condition or clinical state

• The drug therapy involved (causing or solving the problem)

• The specific association between the drug therapy and the patient’s condition

Documenting drug therapy problems

• The medical condition, illness, or complaint involved

• The drug therapy or therapies involved

• The likely cause of the drug therapy problem

Most efficiently documented in the care plan along with:

• The interventions required to resolve the drug therapy problem

• The action that is taken

• The individuals involved